【作者】 陈磊；

【导师】 陈晓平；

【作者基本信息】 四川大学 ， 内科学（专业学位）， 2021， 硕士

【摘要】 目的:肾素-血管紧张素-醛固酮系统(Renin Angiotensin Aldosterone System,RAAS)在血压的调节稳定中起着重要的作用。既往研究发现尽管使用了RASS抑制剂,基线肾素水平升高仍与心血管事件或死亡相关。但研究人群多为心血管疾病患者,尚不清楚高血压患者肾素水平是否与靶器官损害及血压节律异常独立相关。本研究旨在排除药物干扰后探索原发性高血压患者血浆肾素活性与靶器官损害及血压节律的关联性。材料和方法:我们回顾性分析2017年至2020年就诊于四川大学华西医院的未治疗原发性高血压患者,测定了血浆肾素活性(Plasma renin activity,PRA)并根据中位数分为高肾素(≥4.88 ng/ml.h)与低肾素(<4.88 ng/ml.h)两组。使用二元logistic回归分析肾素水平与靶器官损害与血压节律的关系。结果:1.本研究共纳入了211名未治疗原发性高血压患者,平均年龄40.27±14.71岁。根据肾素水平进行分组发现低肾素组以年龄较大的患者为主(平均年龄46.54±14.26岁,男性占45.71%);高肾素患者主要为青年男性(平均年龄34.06±12.36,男性占62.26%)。两组间肾脏损害(白蛋白肌酐比>30 mg/g)、颈动脉损害、清晨血压升高(≥135/85 mm Hg)及非勺型血压差异具有统计学意义。左室肥厚、e GFR异常/肌酐升高在两组之间比较无明显统计学意义。2.单因素logistics回归分析提示高肾素水平与肾功能早期损害相关(OR值:1.921,P=0.045),进一步调整混杂因素包括血糖升高、高甘油三酯及24h收缩压升高、血管紧张素II及醛固酮等,高肾素仍与肾功能损害相关(OR值:2.934,95%CI:1.145-7.523)。3.单因素logistics回归分析提示高肾素水平与清晨血压升高相关(OR值:2.340,P=0.008),进一步调整混杂因素包括年龄、尿酸及甘油三酯升高与血钾后,高肾素仍与清晨血压升高相关(OR:2.119,95%CI:1.011-4.442);但不能独立于血管紧张素II和醛固酮。4.单因素logistics回归分析提示高肾素水平与颈动脉损害(OR值:0.388,P=0.001)及非杓型血压(OR值:0.462,P=0.024)相关,进一步调整混杂因素包括年龄、性别及体重指数后相关性无统计学意义。结论:在原发性高血压患者中较高的PRA水平是肾脏损害的独立危险因素,可能作为临床检测及早期干预的重要靶点。更多还原

【Abstract】 Objective:Renin-angiotensin-aldosterone system(RAAS)is vital to the regulation and stability of blood pressure.Previous studies have found that despite the use of RASS inhibitors,elevated baseline renin levels are still associated with cardiovascular events or death,but the study population is mostly patients with advanced cardiovascular disease.It is unclear whether renin levels are independently related to target organs and abnormal blood pressure rhythm in patients with hypertension.Therefore,this study aims to explore the relationship between plasma renin activity and target organ damage and blood pressure rhythm in patients with essential hypertension after eliminating drug interference.Materials and Methods:This is a retrospective analysis of essential hypertension patients that was admitted to the West China Hospital of Sichuan University from 2017 to 2020.Plasma renin activity(PRA)was measured and divided into two groups according to the median of high renin(≥ 4.88 ng/ml.h)and low renin(< 4.88 ng/ml.h).Binary logistic regression was used to analyze the relationship between PRA and target organ damage and blood pressure rhythm.Results:1.This study included a total of 211 untreated essential hypertension patients(mean age: 40.27±14.71).Grouping according to the level of renin found that the low renin was mainly older patients(mean age: 46.54±14.26,male: 45.71%);the high renin patients were mainly young men(mean age: 34.06±12.36,male: 62.26%).There were statistically significant differences in renal damage(albumin-creatinine ratio > 30 mg/g),morning blood pressure elevation(≥ 135/85 mm Hg),carotid artery damage,and non-dipper blood pressure between the two groups.Left ventricular hypertrophy,abnormal e GFR/increased creatinine were not statistically significant between the two groups.2.Univariate logistics regression analysis suggested that high renin levels are associated with renal function impairment(OR value: 1.921,P=0.045).Further adjustments to confounding factors include increased blood sugar,high triglycerides,and increased 24 h systolic blood pressure,angiotensin II and aldosterone,etc.,high renin is still associated with renal impairment(OR value:2.934,95% CI: 1.145-7.523).3.Univariate logistic regression analysis indicated that high renin levels are related to morning blood pressure elevation(OR value: 2.340,P=0.008).It is still associated with morning blood pressure elevation(OR: 2.119,95%CI: 1.011-4.442)after further adjustments for confounding factors including age,elevated uric acid and triglycerides,and serum potassium,higher PRA;but it cannot be independent of angiotensin II and aldosterone.4.Univariate logistics regression analysis suggests that high renin levels are related to carotid artery damage(OR value: 0.388,P=0.001)and non-dipper blood pressure(OR value: 0.462,P=0.024).Further adjustments for confounding factors include age,The correlation between gender and body mass index was not statistically significant.Conclusion:Higher level PRA is an independent risk factor for renal function damage in patients of essential hypertension,which may be used as an important target for clinical detection and early intervention.更多还原